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General NPI Number Information
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NPI Number | 1093264509
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Entity Type | Organization
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Legal Business Name | PEGASUS HEALTH SERVICES LOUSIANA LLC
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Dates
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Enumeration Date | 09/26/2016
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Last Update Date | 09/26/2016
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Provider Practice Location Address
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Address Line | 8660 FERN AVE STE 120
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City | SHREVEPORT
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State | LA
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Zip | 71105-5649
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Country | US
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Telephone | 903-487-2248
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 837
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City | HOWE
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State | TX
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Zip | 75459-0837
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JEFFEREY ADAIR
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Credential | MD
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Telephone | 903-487-2248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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